TREATMENT

Treatment

 

Immediately after injury

• Rest - The individual is advised to rest the knee from weight-bearing activities allowing the swelling to settle.
  
• Ice - Placing a cold compress or ice pack on the knee is helpful in controlling inflammation as well as helping to reduce pain.
  
• Compression - Utilizing an ace wrap for compression around the knee is beneficial to control the swelling.
  
• Elevation - Lying down with the leg elevated higher than the level of the chest is helpful in controlling and reducing swelling.
  

 

Choices of treatment

Non-surgical treatment

Non-surgical rehabilitation

• You and your doctor may choose nonsurgical rehabilitation if:
  
  • knee is stable during typical daily activities
    
  • knee cartilage hasn't been damaged
    
  • have no desire to participate in high-risk activities involving jumping, cutting and pivoting
    
  • You have a partial tear
    
  • Your knee isn't painful or unstable during normal activities
    
• doctor may recommend physical therapy, changing your activities and wearing a knee brace for possibly risky activities
  
• may also be appropriate for a child or an adolescent with a torn ACL
  
• If the child has no damage other than to the ACL and can avoid high-risk activities, the doctor may recommend postponing surgery until the child's bones have finished growing to avoid damaging the growth plate
  
• goal
  
  • strengthen the muscles around your knee to make up for the absence of an intact ACL
    
• Training focuses on the:
  
  • Hamstring muscles
    
  • Quadriceps muscle
    
  • Calf
    
  • Hip
    
  • Ankle
    
• early stage – work on re-establishing full range of motion in the knee
  
• Then progress to knee-, hip- and ankle-strengthening exercises combined with training to improve your stability and balance
  
• Finally, work on training specific to your sport or work activities, including exercises to help you prevent further injury, such as learning how to land properly from a jump
  
• Patients expected to return to normal their normal daily activities within a month
  

 

Knee brace

• doesn't take the place of the torn ACL
  
• can help stabilize your knee if you should choose nonoperative management while you take part in activities such as skiing, tennis or hiking over uneven ground
  
• usually custom fitted or tailored
  
• can be costly (may not be covered by your insurance provider)
  
• can continue to participate in many of their previous activities that don't involve jumping, cutting and pivoting
  
• may continue to experience instability in your knee during certain types of activities, even while wearing a brace
  
• If this happens, consider making additional changes in your activities or reconsider surgical reconstruction
  
• These repeated events could damage the cartilage and other parts of your knee
  

 

Surgical treatment

Reasons for surgery:

• The knee gives ways during typical daily activities (functional instability)
  
• Patients unable to participate in high risk activities that are important to them
  
• Damage to the meniscus
  

Goals:

• give patients the most stable knee possible so that they can resume their previous level of activity with a safe knee that minimizes the risk of future knee damage
  
• Though most people return to sports activities, some don't return to their previous level of high-intensity sports activity after reconstruction and rehabilitation.
  
• They limit their activities by choice or because of
  
  • Pain
    
  • Swelling
    
  • persistent looseness
    
  • age-related lifestyle changes.
    

 

ACL reconstruction

• replacing ACL with another tendon (graft) from your own body (autograft) or from a cadaver (allograft)
  
• typically come from patellar tendon and hamstring tendon
  

• Procedure
  
  • usually done with arthroscopic techniques
    
  • the graft will be taken from your chosen tendon. A hole is drilled at an angle through the tibia and into the femur, following the path of the injured ACL. The graft is then threaded through the holes, and the small pieces of bone at each end of the tendon are attached to the femur and the tibia, usually with screws, which are left in place permanently
    
• Both grafts are about equal in regard to the number of people who return to their previous level of activity.
  
• If your own tendons don't provide the best replacement for the injured ligament, your doctor may recommend an allograft.
  
• benefit
  
• recovery is usually easier, faster and less painful because you don't have to recover from the removal of the tendon used for the graft
  
• potential complications
  
  • Pain in the front of the knee after ACL reconstruction
    
    • particularly true in patellar tendon graft.
      
  • scar tissue may limit range of motion after surgery. Rarely, this may require a second surgery to correct.
    
  • instability of the knee following ACL reconstruction
    
    • may be related to stretching of the graft over time or re-injury
      
    • more common with allografts than with autografts
      
  • Occasional swelling of the knee can occur despite a successful ligament reconstruction
    
  • Infection
    

 

 

Rehabilitation after surgery

• The knee may be placed in a splint or brace for comfort and protection
  
• It typically takes six to nine months of physical therapy and strengthening exercises before you'll be able to return to your previous level of activity
  
• Some exercises require the use of weight machines, exercise bicycles or treadmills that you might do in a supervised clinic setting
  
• Occur in 3 phases (progression depend on the nature of particular injury and how well patients master the goals within each phases)
  
  • Phase 1
    
    • begins on the first day after surgery
      
    • takes about six to eight weeks
      
    • consists of
      
      • controlling the pain and swelling in the knee
        
      • regaining your range of motion
        
      • preserving muscle strength
        
    • work with a physical therapist a few times a week at first, then once every week or two as they progress
      
    • On days there is no therapy session, patients exercise at home for 30 to 60 minutes a day.
      
  • Phase 2
    
    • typically lasts from two to four months
      
    • focus on
      
      • controlling swelling
        
      • recovering full muscle strength
        
    • In addition to daily strengthening exercises, patients begin stability and balance training
      
    • see the physical therapist less often but continue with 30 to 60 minutes of exercises each day.
      
  • Phase 3
    
    • lasts several months after surgery
      
    • consists of a gradual return to full activity
      
    • requires full motion, normal muscle strength and the absence of swelling
      
    • they continue with stability, balance and strength training as well as training specific to your sport or work activities
      
    • may include exercises to help prevent further injury
      

It's important not to try to return to full activity too soon because your knee may become inflamed or re-injured. The graft needs to heal, and too much stress before it's completely healed may increase the risk of the graft failing.